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Naps To Reduce Fatigue in Doctors while Working Extended Shifts
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What is the problem and what is known about it so far?
During training, doctors often work long hours and are “on call” (working through the night in the hospital) every few days. Over the last decade, concern about the negative effects of these long working hours on patient care and doctors' well-being has increased. Regulations that limit working hours for doctors-in-training to 80 hours per week have been in effect in New York since the late 1980s. In July 2003, the Accreditation Council for Graduate Medical Education passed rules that restrict the number of hours in all programs in the United States. However, doctors-in-training can still work shifts that last up to 30 hours. Strategies to reduce fatigue during these extended shifts could benefit doctors and patient care. One strategy may be to provide the opportunity for doctors to take naps.
Why did the researchers do this particular study?
To see whether providing doctors with the opportunity to nap while they were on call increased sleep and decreased fatigue.
Who was studied?
38 interns (doctors in the first year of residency training) at the University of Chicago Hospital, Chicago, Illinois.
How was the study done?
The researchers assigned doctors to a nap schedule for 2 weeks of every month. On the nap schedule, the doctors could sign over their pagers to a colleague for any period from midnight to 7:00 a.m. so that they could finish their work and take a nap. During the other 2 weeks of each month, they worked a standard schedule, which involved working a 30-hour shift without being able to sign over their pagers and nap. The doctors on the standard schedule could sleep when they finished their work, but they were responsible for answering calls and handling any patient care issues that came up while they were sleeping. The researchers measured the amount of time that each doctor slept by using a device worn on the doctor's wrist to measure movement. Hospital paging logs recorded information about when doctors signed over their pagers. The researchers evaluated fatigue by having the doctors complete a questionnaire.
What did the researchers find?
The intern doctors on the nap schedule slept an average of 41 minutes longer while on the nap schedule than while on the standard schedule even when they did not sign over their pagers. When doctors signed over their pagers, average sleep was 68 minutes longer on the nap schedule than on the standard schedule. Doctors who chose not to sign over their pagers said that they were concerned about the discontinuity in patient care that could result and that they wanted to care for their patients themselves. Although the increases in sleep were modest, doctors reported less fatigue on the nap schedule than on the standard schedule.
What were the limitations of the study?
The study was too small to detect whether the nap schedule improved patient care.
What are the implications of the study?
Providing doctors with the opportunity to nap while working long shifts increases sleep and reduces fatigue. Future studies should evaluate the effect of schedules that permit napping on the quality of patient care.
Article and Author Information
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The summary below is from the full report titled “The Effects of On-Duty Napping on Intern Sleep Time and Fatigue.” It is in the 6 June 2006 issue of Annals of Internal Medicine (volume 144, pages 792-798). The authors are V. Arora, C. Dunphy, V.Y. Chang, F. Ahmad, H.J. Humphrey, and D. Meltzer.
